Observation of efficacy of rt-PA thrombolysis combined with Solitaire AB stent mechanical thrombectomy in patients with acute ischemic stroke: a retrospective analysis.

OBJECTIVE: To observe and analyze the efficacy of recombinant tissue-plasminogen activator (rt-PA) thrombolysis combined with Solitaire AB stent mechanical thrombectomy in patients with acute ischemic stroke. METHODS: Clinical efficacy, neurological function, oxidative stress response, adverse reactions, and quality of life were compared between the two groups. RESULTS: Lower NIHSS scores were observed among patients who received treatment within 2 h after stroke onset when compared with those in a timeframe of 2-6 h, suggesting better neurological function recovery of the patients with early intervention and thus emphasizing the importance of early treatment for patients with stroke onset. Clinical efficacy in the combination group was significantly higher than in the control group (p < 0.05). After treatment, Paraoxonase-1 (PON-1) levels were higher, while lipoprotein-associated phospholipase A2 (Lp-PLA2) and Serum Amyloid A (SAA) levels were lower in the combination group compared to the control group (p < 0.05). The incidence of adverse reactions was significantly lower in the combination group (p < 0.05). At discharge, we observed significantly more patients with good recovery in the combination group when compared to the control group (p < 0.05), suggesting better quality of life of the patients, while this statistical significance was no longer observable at 90 days after discharge (p > 0.05). CONCLUSION: For acute ischemic stroke patients, rt-PA thrombolysis combined with Solitaire AB stent mechanical thrombectomy treatment is effective. It promotes neurological function recovery, improves vascular stenosis, reduces inflammation and adverse reactions, and enhances quality of life, showing promising clinical applications.

Effects of Solitaire AB stent thrombectomy with tirofiban and butylphthalide on neurological function and inflammatory factors in acute cerebral infarction patients.

BACKGROUND: Acute cerebral infarction profoundly affects patients' neurological function and quality of life. This study explores the impact of Solitaire AB stent thrombectomy, combined with tirofiban and butylphthalide, on neurological function and inflammatory factors in patients with acute cerebral infarction. METHODS: Seventy-three eligible patients treated between 2021 and 2023 were divided into a control group (Solitaire AB stent thrombectomy) and a treatment group (Solitaire AB stent thrombectomy with tirofiban and butylphthalide). Postoperative neurological function scores and inflammatory factor levels were analyzed. RESULTS: The treatment group demonstrated a higher clinical effective rate, lower National Institutes of Health Stroke Scale scores at one day and seven days and higher Mini-Mental State Examination and Montreal Cognitive Assessment scores post-treatment. Inflammatory factor levels (Neuron Specific Enolase (NSE), S100-ß, TNF-α and IL-6) were lower in the treatment group. No significant differences in adverse outcomes were observed. CONCLUSION: Solitaire AB stent thrombectomy with tirofiban and butylphthalide shows superior efficacy, improving neurological function and inflammatory factors without increasing adverse outcomes. This offers valuable insights for clinical treatment of acute cerebral infarction.

Image-based visualization of stents in mechanical thrombectomy for acute ischemic stroke: Preliminary findings from a series of cases.

BACKGROUND: Mechanical thrombectomy is the most effective treatment for great cerebral artery embolization within a set time window. Typically, an arteriogram does not show the localization of the stent after release and whether a thrombus is captured or not. Thus, improving the visualization of a stent in interventional therapy will be helpful for clinicians. AIM: To analyze stent imaging findings to enhance clinicians' understanding of a special circumstance, wherein a Solitaire AB retrievable stent was visible during the imaging of a thrombus capture that improved the success rate of stent-based mechanical thrombectomy. METHODS: This was a retrospective study with four acute ischemic stroke (AIS) patients who underwent stent-based mechanical thrombectomy. RESULTS: Patient 1 was a 64-year-old man admitted after 5 h of confusion; angiography revealed basilar artery occlusion. We inserted a stent into the left posterior cerebral artery-P2 segment and visualized the expanded stent that successfully captured a thrombus. Patient 2 was a 74-year-old man admitted with confusion, which lasted approximately 3 h. Angiography revealed a left middle cerebral artery (MCA)-M1 segment occlusion. A stent was deployed in the distal M2 segment, and we could visualize the stent by capturing the thrombus. Patient 3 was a 74-year-old woman admitted after experiencing left hemiplegia for 3 h. We deployed a stent at the distal right MCA-M2 segment, and the developing stent captured a large thrombus. Patient 4 was an 82-year-old man who presented with confusion for 3 h. A developing stent was placed in the distal left MCA-M1 segment, which captured a large thrombus and several fragmented thrombi. CONCLUSION: To the best of our knowledge, this is the first report of stent imaging in patients with AIS. We demonstrated the usefulness and substantial potential of stent imaging in stent-based mechanical thrombectomy for AIS.

Endovascular Treatment of Small Wide-Neck Bifurcation Aneurysms with Single Solitaire AB Stent Technique.

BACKGROUND AND PURPOSE: We present our experience in using the single Solitaire AB stent for small wide-neck bifurcation aneurysms (WNBAs). MATERIALS AND METHODS: During 18 months, 20 small (the largest width <10 mm) WNBAs were treated with the single Solitaire AB stent-assisted coiling. The patients were 12 women and 8 men, with a mean age of 52 years (range: 36-66 years). The mean aneurysm size was 4.2 mm (2-9 mm) and mean neck size was 3.9 mm (2-9 mm). Results at follow-up were graded as complete occlusion, neck remnant, or residual aneurysm. RESULTS: All 20 small WNBAs were adequately occluded after a single Solitaire AB stent placement. There were no procedural ruptures and no thromboembolic complications occurred. Two patients developed a transient neurological deficit. In 20 patients with angiographic follow-up at 6 months, 16 (80%) aneurysms remained adequately occluded. Clinical follow-up in the 20 patients revealed mRS 0-2 in all. CONCLUSIONS: Single Solitaire AB stent-assisted coil embolization for small WNBAs was safe and effective.

Mechanical removal of a refluxed Onyx piece from the middle cerebral artery using the Solitaire Stent: Technical report.

Onyx reflux into the parent artery is a rare and sometimes significant complication in the treatment of cerebral arteriovenous malformations (AVMs). We report a patient who presented with Onyx reflux into the M1 segment of the middle cerebral artery (MCA) during embolization of a right temporal AVM. The refluxed Onyx cast was successfully removed by a mechanical thrombectomy device using a self-expandable and fully retrievable Solitaire AB stent.

Extraction of a migrated coil from the Enterprise stent strut using a Solitaire AB stent.

A 56-year-old woman was admitted to stent-assisted coiling for a 2-mm A1 aneurysm of the left anterior cerebral artery and a left 3-mm internal carotid artery aneurysm. While coiling the A1 aneurysm, the first 2 mm × 20 mm coil migrated through the 4.5 mm × 37 mm Enterprise stent struts, lodging at the distal anterior cerebral artery. A 4 mm × 15 mm Solitaire AB stent was used successfully in this case to remove the displaced coil. The A1 aneurysm was re-treated with a 2 mm × 40 mm coil after placement of the Enterprise stent, and the ophthalmic ICA aneurysm was also coiled through the stent struts. The patient was neurologically intact after treatment.

Solitaire AB stent-assisted coiling embolization for the treatment of ruptured very small intracranial aneurysms.

Recent advances in neuroradiological techniques have increasingly improved the diagnosis rate for very small aneurysms, particularly with the widespread use of three-dimensional cerebral angiography. However, the treatment of very small aneurysms remains a considerable challenge for neurosurgeons. Endovascular coiling has emerged as a potential treatment option for intracranial aneurysms. The aim of the present study was to evaluate the safety and efficacy of Solitaire AB stent-assisted coiling embolization for the treatment of ruptured very small intracranial aneurysms. This retrospective study included nine consecutive patients with ruptured very small intracranial aneurysms (≤3 mm) that underwent Solitaire AB stent-assisted coiling embolization. The aneurysms were located in the ophthalmic branch of the internal carotid artery (n=2), the posterior communicating branch of the internal carotid artery (n=4), the top of the basilar artery (n=1) and the middle cerebral artery (n=2). Solitaire AB stents were successfully implanted in all nine patients. Of the nice individuals, six patients exhibited complete occlusion at Raymond grade I and three patients exhibited occlusion at Raymond grade II. No aneurysm rupture was observed during the surgery. During the follow-up period of 8-13 months, no intracranial hemorrhage occurred. A total of seven patients underwent follow-up digital subtraction angiography at 5-10 months post-intervention. No recurrence of the aneurysms and no stenosis or occlusion of the parent arteries was observed. Therefore, Solitaire AB stent-assisted coil embolization was demonstrated to be a safe and effective treatment for ruptured very small intracranial aneurysms. The long-term efficacy of this technique may be improved by increasing the packing density around the aneurysmal neck and improving the hemodynamics.

Clinical efficacy of tirofiban combined with a Solitaire stent in treating acute ischemic stroke

This study explores the safety and effect of acute cerebral infarction treatment by microcatheter injection of tirofiban combined with a Solitaire AB stent and/or stent implantation. Emergency cerebral angiograms showing the responsible vascular occlusion of 120 acute cerebral infarction patients who underwent emergency endovascular thrombectomy were included in the study. These patients were randomly divided into two groups using the random number table method: treatment group (n=60) that received thrombectomy (with cerebral artery stents) combined with intracerebral injection of tirofiban and control group (n=60) that only received thrombectomy (with cerebral artery stents alone). The baseline data, cerebral angiography before and after surgery, hospitalization, and follow-up results of patients in these two groups were compared. Furthermore, the incidence of major adverse cerebrovascular events of these two groups was compared (90-day modified Rankin scale, a score of 0-2 indicates a good prognosis). The difference between baseline clinical data and brain angiography between these two groups was not statistically significant. Patients in the treatment group had a higher prevalence of thrombolysis in cerebral infarction grade 2b/3 than patients in the control group (88.3% (53/60) vs 66.7% (40/60), P=0.036). Moreover, the National Institutes of Health Stroke Scale scores 7 days after surgery and the 90-day prognosis were all better for the patients who received tirofiban (P=0.048 and P=0.024). Mechanical thrombectomy with Solitaire AB stents in combination with the injection of tirofiban through a microcatheter appears to be safe and effective for the endovascular treatment of acute ischemic stroke.

Mechanical thrombectomy using a solitaire stent in acute ischemic stroke; initial experience in 40 patients.

OBJECTIVE: This study was conducted in order to demonstrate the initial experience of the Solitaire AB stent in mechanical intracranial thrombectomy. METHODS: We conducted a retrospective review of 40 consecutive patients who underwent intra-arterial Solitaire AB stent thrombectomy for treatment of acute ischemic strokes between October 2010 and November 2011. Demographic, clinical, and radiological presentations and outcomes were studied. RESULTS: Twenty six men and 14 women with a mean initial National Institutes of Health Stroke Scale (NIHSS) score of 14.1 (range, 8-26) and a mean age of 65.4 (range, 32-89) years were included in this study. Occlusion sites were as follows: internal carotid artery (n = 11), middle cerebral artery M1 (n = 22), M2 (n = 5), and basilar artery (n = 2). Successful revascularization was achieved in 36 (90%) patients. The mean NIHSS score was 11.6 (range, 1-23) at 24 hours after the procedure, and 42.5% of patients showed a modified Rankin scale score of ≤ 2 at 90 days. New occlusion by migrated emboli was observed in one (2.5%) case. Post-procedural intracerebral hemorrhage occurred in only one case (2.5%), with an all-cause mortality of two (5%). CONCLUSION: The Solitaire AB device is a relatively safe and effective tool for use in performance of mechanical thrombectomy in patients with acute ischemic stroke.

Waffle-Cone Technique Using Solitaire AB Stent.

The waffle-cone technique is a modified stent application technique, which involves protrusion of the distal portion of a stent into an aneurysm fundus to provide neck support for subsequent coiling. The authors report two cases of wide necked basilar bifurcation aneurysms, which were not amenable to stent assisted coiling, that were treated using the waffle-cone technique with a Solitaire AB stent. A 58-year-old woman presented with severe headache. Brain CT showed subarachnoid hemorrhage and angiography demonstrated a ruptured giant basilar bifurcation aneurysm with broad neck, which was treated with a Solitaire AB stent and coils using the waffle-cone technique. The second case involved an 81-year-old man, who presented with dizziness caused by brain stem infarction. Angiography also demonstrated a large basilar bifurcation unruptured aneurysm with broad neck. Solitaire AB stent deployment using the waffle-cone technique, followed by coiling resulted in near complete obliteration of aneurysm. The waffle-cone technique with a Solitaire AB stent can be a useful alternative to conventional stent application when it is difficult to catheterize bilateral posterior cerebral arteries in patients with a wide-necked basilar bifurcation aneurysm.